Chapter 158: Crisis in the ICU

All patients in the ICU are in critical condition; even when complications arise, they aren’t typically rushed into the Operating Room for emergency care, right?

Zhou Can sensed something was off about this situation.

Even if a patient needs resuscitation, it’s usually done right there in the ICU ward.

The unit is equipped with various emergency facilities.

Defibrillators, precise infusion pumps, ventilators, multi-functional blood purifiers, complete life-monitoring systems – even the extremely expensive ECMO. In short, as long as the family refuses to remove life support, even the gravest cases rarely result in death once in the ICU.

No breath? Just put them on a ventilator.

Heart stops? Breath ceases? No worries – hook them up to ECMO.

Modern medical technology has indeed given rise to countless life-saving miracles.

ICU patients incur hefty treatment fees. Typically, each nurse is assigned to two patients, and a doctor oversees at most three beds, with a chief attending on hand. Tasks like cleaning up after patients are handled by dedicated aides.

With so many people attending to one patient, if the patient still can’t pull through despite maximal resuscitation efforts, the hospital can claim they did everything possible.

However, if a patient is rushed into the Operating Room for emergency treatment, the situation takes on an entirely different nature.

Zhou Can’s intuition told him that choosing to move a critically ill patient to the OR was either to perform necessary checks or assist in a procedure—or it signaled a major oversight by the on-duty staff.

In that case, the best remedy would be to do everything possible to salvage the patient afterward.

“I’m not fully clear on the details. Director Wu is off giving a lecture at the school and won’t be back anytime soon. The doctors in his team are notoriously proud and image-conscious. They wouldn’t have sought my help unless they were completely out of options. Let’s go over there and help in any way we can.”

Director Wen isn’t exactly old – he’s under sixty.

He practically walks with a breeze at his back.

In no time, he whisked Zhou Can, Dr. Zou, and Tang Li over to the scene.

Not a single one of the resident doctors had been summoned.

In such circumstances, bringing along two attending physicians not only underscores the gravity of the matter but also gives the junior attendings a chance to learn.

After all, every hand that can help at a critical moment counts.

Taking Zhou Can along wasn’t just for training – it was also a sign of reliance on his skills.

Zhou Can’s expertise in endoscopic procedures and pathology diagnosis makes him a real force on the team.

Before the four reached the Operating Room, a stout middle-aged doctor intercepted them.

“Director Wen, we’re glad you’re here! That patient is on the brink – please take a look!” The forty-five or sixty-year-old man, as if he’d seen a savior, eagerly pulled Director Wen over.

Zhou Can recognized him; he was an associate chief physician under Wu Baihe, named Kuang Shenfeng.

Although they didn’t belong to the same team, two months working in the General Surgery Department had let him get acquainted with most of the department’s nurses and doctors.

This was far different from the pitiful familiarity one had as an intern.

Many interns only knew the higher-ups and nurses in their own department, barely leaving any impression on them.

In a way, it makes sense – interns in a hospital hardly have any rights; they’re even below the cleaning staff in some respects.

In contrast, trainees like him hold a comparatively higher status.

Yet, even that is limited.

Zhou Can was an exception.

His standing in the General Surgery Department was quite high. In Director Wen’s team, everyone treated him like an attending physician.

Members from other teams had also heard of or witnessed Zhou Can’s endoscopic prowess; many would approach him with a friendly smile upon meeting him.

The nurses, especially the ladies, were even more so – each one sharp and capable.

Even the ICU nurses would greet Zhou Can warmly, sometimes striking up a brief chat.

“Where’s the patient?”

Director Wen asked bluntly.

It seemed the patient hadn’t been taken into the Operating Room after all.

“Right here – I was just about to have the team take him for a CT angiography,” came the reply.

On a mobile bed lay a gaunt, emaciated middle-aged man, probably in his forties or fifties.

He had a catheter in place; his trachea had been surgically opened and an extra tube inserted.

He was on a ventilator.

Even so, the patient’s labored breathing and wheezing were evident.

Both the attending doctors and nurses pushing the ventilator and bed sported tense expressions.

“His blood pressure is a bit low! And his oxygen saturation is equally alarming… Briefly, what triggered his condition and what do we know about his overall status?”

After reviewing the case, Director Wen’s expression grew even more grave.

“Sigh! I suppose part of this is my fault. I had a bout of stomach pain while on duty and rushed to the restroom. Soon after, a nurse called to report that this patient was breathing rapidly and seemed to be struggling. He was fine when I left, so I didn’t pay much heed. Besides, this patient has been in a coma for days, bedridden, and tracheotomized in the ICU.”

“It’s unlikely that a patient who’s been stable for so many days would suddenly suffer a dramatic event. My stomach was in knots, leaving me stuck in the restroom for a while. When I inquired about his condition, the nurse mentioned there were no signs of cyanosis, and his fingertip oxygen saturation wasn’t low. Based on these symptoms, I diagnosed him with a lung infection.”

“In fact, the patient’s lung infection had been brewing for a while. He had a malignant brain tumor for which he underwent surgery and chemotherapy – with little success. His family insisted on treatment, so he was kept under close observation in the ICU.”

Prolonged intubation makes one highly susceptible to inflammation and infection.

Since the patient already had a lung infection, symptoms like wheezing and rapid breathing might not raise alarms for most doctors, especially when oxygen levels remain stable.

Compared to other perilous ICU conditions, a bit of labored breathing hardly seems critical.

“I instructed the nurse to suction his airway, reposition him, and pat his back. If he still wheezed, we’d proceed with nebulization.”

Associate Chief Physician Kuang Shenfeng briefly outlined the situation.

Although his approach might have seemed a bit hasty, it was by the book and not considered erroneous.

“After that, the nurse didn’t call me again. I relaxed a bit, finished my business, and when I returned, my legs were terribly numb. I sat outside for a while before heading back to the ICU. Upon checking, I noticed the patient still exhibited rapid breathing, but nothing else was overtly abnormal.”

“Coincidentally, another patient went into ventricular fibrillation, and I rushed off to manage that case. In under an hour, the monitor for this patient started alarming – blood pressure plummeted, and his heart rate and respiration became erratic. That’s when I realized our earlier measures might have been too rash.”

Kuang Shenfeng recounted the incident with a tone full of regret.

In Zhou Can’s eyes, Kuang Shenfeng was one of the strongest surgeons under Wu Baihe, unchallenged at the top of the heap.

His promotion to Associate Chief Physician spoke for itself.

It just goes to show that sometimes, success or failure can hinge on a split-second decision.

Doctors and nurses alike know that even a momentary lapse in attention can cost a life.

“Why not resuscitate directly in the ICU?”

Director Wen was certain that Kuang Shenfeng understood the underlying implication of his question.

“Because the patient has been bedridden for so long, I highly suspect a pulmonary embolism. This condition is extremely dangerous. My misdiagnosis and negligence have already cost us over an hour. I thought taking him to the Operating Room might at least show a proactive attitude toward resuscitation – it would be easier for the family to accept if something went wrong, and the ensuing outcry would likely be less severe,”

Kuang Shenfeng’s tone wavered as he spoke.

Clearly, there were things left unsaid.

If things went wrong and the family erupted, an investigation into the patient’s death – citing misdiagnosis, negligence, or delayed intervention – would spell disaster for him.

At the very least, a proactive rescue stance would mitigate the fallout.

“Pulmonary embolism is certainly a strong possibility. Have we done any tests?”

“So far, only an ECG has been done. I sent it to Director Wu, and he too believes the likelihood of a pulmonary embolism is high. We’re now preparing to take him to the CT suite for an angiography. Once we determine the cause, we can decide whether to proceed with thrombolysis or need interventional removal of the clot.”

Kuang Shenfeng answered.

It seemed Zhou Can had misunderstood, thinking that Kuang Shenfeng was rushing the patient to the OR.

The mix-up was almost laughable in hindsight.

Having reached Associate Chief Physician level, even in emergencies, he could distinguish between what was urgent and what wasn’t. He maintained proper decorum in his actions.

Taking the patient for further tests was indeed the right call.

“I also reviewed the ECG – it clearly points to a pulmonary embolism.”

Du Leng was also present during the resuscitation.

Almost every member of the medical team was united in such emergencies.

When faced with sudden critical conditions, unity is the only way to save a life.

His words carried a significant weight.

From the confidence in his tone, it was evident he saw himself as a key player.

Other doctors and nurses treated him with considerable respect.

“Dr. Zhou, what’s your take?”

After assessing the situation, Director Wen didn’t immediately offer his opinion; instead, he turned to Zhou Can.

All eyes instantly fixed on Zhou Can’s face.

Some even silently compared him to Du Leng.

Both were outstanding trainees of their cohort, each with exceptional performance.

In the two months of General Surgery Department training, Zhou Can hadn’t had many direct encounters with Du Leng.

Occasionally during departmental consultations or surgeries jointly led by Wu Baihe and Director Wen, Zhou Can and Du Leng would appear together.

During these discussions, Zhou Can typically held back his opinions.

Du Leng, on the other hand, was noticeably high-profile.

He often engaged in debates with several department heads.

As for surgeries, Du Leng’s skills were rather ordinary. In procedures rated level 3 or 4, he was mostly a bystander.

Key portions of many endoscopic procedures were invariably handled by Zhou Can.

That’s why among the department, Zhou Can and Du Leng were humorously dubbed the surgical genius and the theoretical genius, respectively.

Now, with Director Wen publicly asking for Zhou Can’s diagnostic opinion – especially after both Wu Baihe and Du Leng had already spoken – it was clear how highly Director Wen regarded him.

“I remember when I first joined the Emergency Department training, my teacher once told me something like this: When a terminally ill, bedridden patient is hospitalized, what you witness isn’t always a medical miracle – sometimes it’s just the calm before a catastrophic medical mishap.”

Rather than offering his diagnosis immediately, Zhou Can uttered these provocative words that could worsen the already tenuous doctor-patient rapport.

This earned him scornful glances from many doctors and nurses.

In times like these, neglecting to act immediately while insinuating ulterior motives was unforgivable.

Such outrageous comments practically begged for divine retribution.

“What exactly do you mean?”

Kuang Shenfeng’s voice turned icy.

He had always been haughty and looked down on several of Director Wen’s subordinate doctors.

Zhou Can’s words undoubtedly struck a nerve.

The term ‘medical mishap’ was something Kuang Shenfeng least wanted to hear.

“You’re suggesting that this isn’t a pulmonary embolism. If you had proceeded with thrombolytic rescue on him, it would have undoubtedly turned into a medical mishap,” Zhou Can stated coolly, seemingly unfazed by the disdainful looks from other doctors.

At these words, Kuang Shenfeng’s expression grew even frostier as he glared at Zhou Can with contempt and disgust.

“Director Wen, let’s take the patient for a CT angiography. Once we determine the nature and severity of the pulmonary embolism, please help us with the resuscitation,”

Kuang Shenfeng clearly dismissed Zhou Can’s diagnosis, though he held back for the sake of Director Wen’s authority.

“Alright!”

Director Wen naturally didn’t oppose.

After all, he was there to assist at the other team’s request.

It was understood that the other team’s treatment plan would take precedence. To put it bluntly, if the patient couldn’t be saved or something went wrong, they’d just shrug and leave without any accountability.

“Dr. Zhou, are you absolutely sure this patient doesn’t have a pulmonary embolism?”

Director Wen valued Zhou Can’s opinion greatly.

In these two months, Zhou Can had repeatedly offered unconventional yet accurate insights during consultations.

His diagnostic approach was markedly different from others.

“I believe it isn’t a pulmonary embolism. Some superficial symptoms may resemble it, but my gut tells me it’s related to the lungs rather than the primary cause,” Zhou Can asserted calmly.

“Let’s wait for the test results; in the meantime, we can review the patient’s previous reports to better understand his condition and medical history.”

Director Wen gathered the group into a nearby conference room, pulling out the patient’s files and reports for review.

It was then evident that there were still underlying divisions between the teams.

While Zhou Can’s group discussed the root cause of the patient’s ailment, Wu Baihe’s team—led by Kuang Shenfeng and Du Leng—deliberated on how to proceed once the CT results confirmed a pulmonary embolism.

Their plan was to perform an interventional procedure in the Operating Room – a high-risk operation.

Naturally, they’d need to obtain the family’s consent first.

If they could help the patient through this crisis, Kuang Shenfeng might be able to deflect blame for his earlier oversights.

Soon, the angiography results were in.

The CT scan showed fluid accumulation in the lungs, but no significant pulmonary embolism was detected after the CT-A review.

It turned out that the patient’s overall blood circulation was in poor shape.

For long-term bedridden patients, blood stasis is common.

This result was utterly unexpected.

At that moment, Kuang Shenfeng recalled Zhou Can’s earlier words.

Among all the doctors involved in the resuscitation, only Zhou Can had diagnosed the patient as not having a pulmonary embolism.

“Dr. Kuang, after the tests the patient’s breathing has weakened further. His systolic blood pressure has dropped below 110—I’m afraid he won’t last much longer. Should we send him back to the ICU, or what’s the plan?”

In such a situation, returning him to the ICU for resuscitation wouldn’t mean much.

Without a clear diagnosis, the patient was bound to die.

No matter how advanced the ICU equipment is, it isn’t a panacea.

Medical staff in the ICU know all too well that even amidst high-tech gear, the alarms from the life-monitoring systems never cease.

Every alarm from a bed means a crisis is unfolding.

Without timely intervention—even with ventilators, ECMO, or the most expensive drugs—death can still be inevitable.

Upon hearing this dire news, Kuang Shenfeng felt as if he’d heard a death knell.

Gone was his previous arrogance and composure.

Cold sweat broke out on his forehead, and panic shone in his eyes.

He pulled out his phone and dialed Wu Baihe’s number.

After a brief report on the situation, he said,

“Doctor, the tests show that the patient doesn’t have a pulmonary embolism. His breathing is extremely weak and his systolic blood pressure has fallen below 110. What should we do?”

Kuang Shenfeng was clearly seeking help from Wu Baihe, indicating his deep distrust of Director Wen’s team.

When it came to critical matters, he trusted only Wu Baihe.

In his eyes, Wu Baihe was almost like a deity.

“I heard Dr. Zhou has determined that the patient doesn’t have a pulmonary embolism, right?” Wu Baihe’s network was impressively swift—he already knew what was happening on scene.

“Yes,” Kuang Shenfeng replied with difficulty.

Whether he admitted it or not, reality had hit him hard.

Zhou Can’s honest, albeit harsh, words were all correct.

“I’ve already headed back to the hospital – I should be there in about twenty minutes. Truth be told, in a case this tricky, I might not even be able to manage things from the sidelines. Listen to Dr. Zhou; do exactly as he advises. It might be our only shot at saving him.”

Wu Baihe’s words left Kuang Shenfeng utterly dumbfounded.